Download 노재훈2이상기압

이상기압
고도에 따른 기압, 산소분압 및 온도
고도(m)
0
500
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
11,000
15,000
20,000
기압(mmHg)
760
716
674
596
525
462
405
354
308
267
231
198
90.3
41.4
PO2 ,mmHg
103
61
(3-4주)
25
(11-12주)
109
0
기압비
1.00
0.94
0.89
0.78
0.69
0.61
0.53
0.47
0.41
0.35
0.30
0.26
0.12
0.05
1기압 = 760mmHg = 1013.25millibar, 109, 100% 산소 흡입시
온도(oC)
15.00
11.75
8.50
2.00
-4.49
-10.98
-17.47
-23.96
-30.45
-36.93
-43.41
-49.89
-56.50
-56.50
이상기압하에서의 작업
• 고기압
• 저기압
• 급격한 기압변동
고기압이 인체에 미치는 영향
• 기계적 장해
• 화학적 장해
기계적 장해
barotrauma
ear squeeze
sinus squeeze
dental squeeze
lung squeeze
abdominal gas pain
화학적 장해
질소 마취작용(nitrogen narcosis)
– 증상
–
–
예방책 : helium diving의 장단점
martini rule
수심과 질소마취 증상과의 관계
수심(m)
증 상
30-45
현기증, 자신감의 증가, 세밀한 식별능력 소실, 다행증
45-60
명렁하고 상쾌한 기분, 다변증
60-75
자신의 안전에 대해 부주의, 웃음, 집중력 감소
90
우울상태, 명확한 사고의 소실, 신경-근의 협동작용 장해,
거동의 변동
105
의식소실
산소중독
산소분압 2기압(1550 mmHg) 이상
1. Visual disturbance
Euphoria
Nausea
Twitching
Incoordination
Dizziness
2. Lorrain - Smith효과(만성형)
Paul-Bert효과(급성형)
고압신경증후군
(High pressure nervous syndrome)
– Tremor, convulsion, dizziness,
nausea, vomiting
– 15 ATA
급격한 기압변동에 의한 신체장해
• 감압병(decompression sickness)
• 이압성 골괴사
감압병(decompression sickness)
동의어
A. 잠함병(caisson disease)
B. 벤즈(bends)
C. 초크스(chokes)
D. 스테거즈(staggers)
E. 공기 전색증(air embolism)
– 유발요인
A. 운동
B. 손상
C. 한냉
D. 비만증
E. 이산화탄소 농도
F. 연령
G. 음주
– 임상증상
A. Type Ⅰ : 비교적 경한 형태로 통증을 수반하며
임파부종과 피부소양증이 나타나기도 한다.
B. Type Ⅱ : 심한형태로 질식(chokes), 신경계 증상,
내이증상(staggers),복통, 흉통, 요통 동반
이압성 골괴사
(dysbaric osteonecrosis, aseptic bone necrosis)
– 원인
기체성 기포, 지방성 색전
– 호발부위
대퇴골의 하단 골간부, 두부
경골의 상단 골간부
상완골의 두부, 경부
수심에 따른 압력과 증상
0m
10
20
30
1ATA
2
3
4
90
10
no decompression
N2 narcosis
O2 toxicity
Hyperbaric Chamber
Modified USN Table 5
Depth: 18msw., Atmosphere: air mix., Use: Treatment of CO poisoning.
Comment: Can be extended if patient's condition indicates requirement for more
prolonged treatment
•
감압병의 예방
• 적성검사
비만자, 호흡기 질환자, 이비인후과 질환
자, 알콜중독자, 약물중독자, 골관절 질환자
– 작업시간 제한
– 단계적 감압 실시
– 반복 잠수 금지
– 헬륨 잠수
– 재가압
저기압에 의한 인체 장해
• 기계적 장해
• 저산소증(hypoxia)
• 고산병
기계적 장해
– aerotitis media
– aerosinusitis
저산소증(hypoxia)
– 저산소환경에서 순화
호흡횟수 및 깊이 증가 → 호흡성 알카리증 →
맥박수, 심박출량 증가 → 적혈구수 증가,
혈색소량 증가, 혈액량 증가
– 3,000m → 3 ∼ 4주에 순화
6,000m → 11 ∼ 12주에 순화
Altitude Illnesses
•
•
•
•
Acute Mountain Sickness (AMS
High Altitude Pulmonary Edema (HAPE)
High Altitude Cerebral Edema (HACE)
Cheyne-Stokes Respirations
저기압 대책
순응
약물요법
가압
산소흡입
Preventing Acute Mountain Sickness
Acute mountain sickness is caused by a lack of oxygen
when traveling to higher elevations. This usually occurs in
individuals exposed to an altitude over 7,000 feet (2,100
m) who have not had a chance to acclimate to the
altitude before engaging in physical activities. Mountain
climbers, trekkers, skiers, and travelers to the Andes or
Himalayas are at greatest risk. While individual tolerance
varies, symptoms usually appear in several hours, with
those in poor physical condition being most susceptible.
Headache, fatigue, shortness of breath, nausea, and poor
appetite occur initially. Inability to sleep is also frequently
reported. In more severe cases thinking and judgement
may become impaired. An uncommon but potentially fatal
complication called high altitude pulmonary edema,
caused by fluid build-up in the lungs, can also occur.
Gary P. Barnas, MD
Associate Professor
General Internal Medicine
The symptoms of acute mountain sickness can be
prevented or minimized by gradually ascending (less than
500 meters/day)over several days to give your body a
chance to acclimate to the higher altitude. Taking the
prescription medication Diamox (acetazolamide) 250 mg
three times a day has been shown to speed up the
acclimatization process and can be taken shortly before
and during the ascent. Do not take this medication if you
are allergic to sulfa drugs. This medication is a mild
diuretic and may work by changing the body's acid-base
balance and stimulating breathing. Dexamethasone 8 mg
once a day has also been shown to be effective. However,
this steroid medication may have more adverse effects.
Once symptoms occur, they usually improve over several
days without treatment. However, if they become severe,
they can be relieved with the administration of oxygen or
descent to a lower altitude.
Gary P. Barnas, MD
Prevention of Altitude Illnesses
Prevention of altitude illnesses falls into two categories, proper
acclimatization and preventive medications. Below are a few basic
guidelines for proper acclimatization.
•If possible, don't fly or drive to high altitude. Start below 10,000 feet (3,048
meters) and walk up.
•If you do fly or drive, do not over-exert yourself or move higher for the first 24
hours.
•If you go above 10,000 feet (3,048 meters), only increase your altitude by 1,000
feet (305 meters) per day and for every 3,000 feet (915 meters) of elevation
gained, take a rest day.
•"Climb High and sleep low." This is the maxim used by climbers. You can climb
more than 1,000 feet (305 meters) in a day as long as you come back down and
sleep at a lower altitude.
•If you begin to show symptoms of moderate altitude illness, don't go higher until
symptoms decrease (&quotDon't go up until symptoms go down").
If symptoms increase, go down, down, down!
•Keep in mind that different people will acclimatize at different rates. Make
sure all of your party is properly acclimatized before going higher.
•Stay properly hydrated. Acclimatization is often accompanied by fluid loss, so
you need to drink lots of fluids to remain properly hydrated (at least 3-4 quarts
per day). Urine output should be copious and clear.
•Take it easy; don't over-exert yourself when you first get up to altitude. Light
activity during the day is better than sleeping because respiration decreases
during sleep, exacerbating the symptoms.
•Avoid tobacco and alcohol and other depressant drugs including,
barbiturates, tranquilizers, and sleeping pills. These depressants further
decrease the respiratory drive during sleep resulting in a worsening of the
symptoms.
•Eat a high carbohydrate diet (more than 70% of your calories from
carbohydrates) while at altitude.
•The acclimatization process is inhibited by dehydration, over-exertion, and
alcohol and other depressant drugs.